Malaria Communities Program: Building Community Capacity in Malaria Control

This 6-page brief, published by the Maternal and Child Health Integrated Program (MCHIP), shares the experience of The Malaria Communities Program (MCP), launched in December 2006. Through 20 awards to 18 partners in 12 countries, the President’s Malaria Initiative (PMI) has supported efforts of communities and non-governmental organisations to combat malaria at the local level. This document shares case studies highlighting programme results, and describes how MCP grantees built community capacity for malaria control. According to the brief, interventions implemented without community partnership risk being culturally insensitive and contextually inappropriate, and may ultimately fail to achieve reductions in malaria morbidity and mortality. Building community capacity by engaging community health workers, community leaders, village health committees, and other community structures is an essential step to effective malaria control and the means to achieving sustainable impact.

The brief examines different models of community outreach and engagement implemented by five MCP partners: the Christian Reformed World Relief Committee (CRWRC) Malawi, HealthPartners Uganda, Catholic Medical Mission Board (CMMB) Zambia, Aga Khan Foundation (AKF) Mozambique in partnership with Progresso, and Lutheran World Relief (LWR) Mali. MCHIP collected multiple forms of data from these five partners using qualitative methods, including individual interviews with key project personnel and review of key documents. MCHIP then compared data across projects to better understand the overall contributions made by MCP.

The major sub-theme emerging from the data was effective utilisation of community volunteers as a way to build community capacity and sustain project results. Each partner's strategy to engage and retain volunteers included these key attributes: selection of volunteers, motivation/retention of volunteers, ensuring sustainability of the volunteer programme, and addressing challenges. MCP partners laid the groundwork for community ownership by ensuring that the volunteers gained the respect of their communities. MCP partners used creative methods to motivate and retain volunteers. Following the Care Group methodology, CRWRC Malawi’s volunteers were responsible for visiting just 10 households (identified as a manageable target) each month in their catchment area. To help volunteers recoup economic losses from time spent on volunteer duties, HealthPartners Uganda linked Village Health Team (VHT) members to Village Savings and Loan activities. MCP-supported volunteers adopted leadership roles in their communities. As integral community members, volunteers conveyed key malaria messages to their communities, who were more receptive of messages provided by their own leaders than those from external health workers.

One challenge identified was the singular programme focus. MCP projects found that communities looked for other messages from volunteers related to different health subjects. The Program Director from Progresso, in Mozambique, explained: "This project had a very narrow focus on malaria. We found that this is not very useful in the community. At the community level there should be more integrated programming that can meet the various needs of the households.” Future programmes can leverage the platforms created by MCP partners through strengthened volunteer cadres to address other health problems.

The following key messages were derived from this programme:

• Messages delivered by volunteers were well-received. MCP partners reported that working through community volunteers was key to their achievements because volunteers could deliver context-specific malaria messages frequently.
• Volunteers linked communities and health facilities. Close collaboration helped to integrate the community and facility health systems through standardised behavioral messages, services adjusted to need and context, and empowered community members. Community participation in volunteer selection contributed to a sense of ownership of the process and product (health messages).
• Motivating volunteers required innovation and community involvement. MCP partners worked within specific contexts to create systems to support volunteers. Community selection of volunteers fostered their accountability to their own community rather than to the NGO or project. Leadership in their communities is an incentive for many volunteers.